Autologous Pericardial Patch Research Articles

A successful surgical repair for supravalvular aortic stenosis with a bicuspid valve and malpositioned coronary orifices by partial Brom’s technique: a case report

BackgroundSupravalvular aortic stenosis (SVAS) is a relatively rare form of left ventricular outflow tract obstruction, often accompanied by other cardiac conditions. However, a standard surgical reparative technique has not been established and repairing SVAS remains challenging.Case presentationWe repaired SVAS of a 3-year-old boy accompanied by a bicuspid aortic valve and malpositioned coronary orifices by partial Brom’s technique with two glutaraldehyde-treated autologous pericardial patches, using recent advanced preoperative information, including geometric and effective heights. Echocardiography after the surgery revealed release of SVAS without aortic regurgitation.ConclusionsIn repair for SVAS, it is important not only to release stenosis but also to make a functional aortic valve, using recent advanced preoperative information. In the case of children, repairing the aortic valve by only using autologous tissue having growth potential, is also important.

Outcomes of the Modified Warden Procedure for Partial Anomalous Pulmonary Venous Connection Drainage to a High Location in the Superior Vena Cava

To report the safety and effectiveness of a modified Warden procedure. Twenty-six (26) patients underwent modified Warden surgery at our centre from September 2017 to September 2021. In all patients, the superior vena cava (SVC) was reconstructed by turning the atrial wall in the main body of the right atrium upwards and applying fresh autologous pericardial patches. There were 13 male patients and 13 female patients, and the median age of the patients was 7.0 (range, 0.3-47.0) years. The median follow-up time after surgery was 47.0 (range, 32.0-80.0) months. The aortic cross-clamp time was 108.50±34.72 minutes, the cardiopulmonary bypass time was 154.81±41.65 minutes, the median postoperative mechanical ventilation time was 8.5 (range, 0.0-91.0) hours, the median intensive care unit stay was 43.5 (range, 15.0-352.0) hours, and the median length of postoperative hospital stay was 7.0 (range, 6.0-19.0) days. All patients were safely and successfully discharged from the hospital. No deaths or sinus node dysfunction occurred during the follow-up period. The mean gradient of the reconstructed SVC and/or the right pulmonary vein (PV) increased in eight patients and decreased to less than 1 mmHg in six patients. One (1) adult patient had already undergone two vascular interventions, and one child had persistent stenosis but did not undergo reoperation at the time of the study. In addition, two patients were subjected to pericardial windowing. A modified Warden technique using a right atrial flap and autologous pericardium effectively corrected the high-plane connection between the PVs and SVC. This technique effectively avoids sinus node dysfunction; however, a short-term increase in the differential pressure of the re-established SVC or PV after the procedure is acceptable, and reintervention is required only in rare cases.

Minimally invasive autologous pericardial patch reconstruction of the pulmonary artery for locally advanced lung cancer following neoadjuvant treatment

Minimally invasive autologous pericardial patch reconstruction of the pulmonary artery for locally advanced lung cancer following neoadjuvant treatment

Use of autologous pericardial patch graft for treatment of large congenital peritoneopericardial diaphragmatic hernia in two cats

AbstractPeritoneopericardial diaphragmatic hernia is a congenital structural anomaly that results in a communication between the pericardial sac and the peritoneal cavity. About 50% of cats are asymptomatic at the time of diagnosis, and the remaining animals may show respiratory (dyspnoea, tachypnoea, exercise intolerance), gastrointestinal, cardiac tamponade or non‐specific clinical signs. Median celiotomy for herniorrhaphy without tension (primary closure, muscle flaps, synthetic mesh, pericardium) is the treatment of choice for symptomatic patients. Two cats were referred with respiratory signs, secondary to a peritoneopericardial diaphragmatic hernia. A pericardial patch graft was obtained and sutured to the diaphragm as an alternative technique to close the large defect and not cause excessive tension on the diaphragm and caval foramen. Patients recovered well without any complications after surgery. Re‐examination and thoracic radiographs at 1 week, 2 weeks, 3 months, 6 months and 3 years postoperatively showed no signs of recurrence and the patients remained asymptomatic.

Pedicled pericardial patch in tracheal reconstruction in children – Novel technique to provide vascularized tissue for salvaging difficult airways

BackgroundManagement of large central airway defects are often complex. Children who present with these defects have multiple co-morbidities or have had previous surgeries. Surgical options include various tissue cover for these defects without longer term benefits. Vascularized autologous pericardial patch offers a better solution to these defects by providing vascularity and potential for remodelling in future. Methods41 children (M:F of 24:17) were operated for large trachea-bronchial defects between January 2015 and August 2022. The median age of was 12 months with median weight of 8.9 kg (IQR 3.3 kg–17.7 kg) Causes leading to the central tracheal defect include failed repair of previous trachea-oesophageal fistula (TOF) (n = 21) and acquired fistula due to button battery injury (n = 11). Surgical repair consisted of autologous pedicled pericardial patch repair for the airway defect under cardiopulmonary bypass. ResultsThere were two operative deaths related to extensive sepsis and necrosis of reconstructed trachea. Four children had further reoperation with additional patch. Bronchoscopy was used as surveillance in all these children, with use of airway stents (biodegradable stent) in 9 children. The median ventilation time was 8 days, with tracheostomy being needed in 5 for long term support. ConclusionsAutologous pericardial patch is a versatile technique and can be used to salvage large tracheal defects when other method have failed or not feasible. Tracheomalacia at the site of repair could be managed with biodegradable stents. Vascularity and ciliary function of the patch still needs to be evaluated.

Mitral valve repair for infective endocarditis after esophageal reconstruction: a case report

BackgroundIn patients with retrosternal neo-esophageal conduit after right thoracotomy, the approach to cardiac surgery could be challenging. Particularly, in patients with infective endocarditis, there is a risk of injury to the conduit through standard median sternotomy. Moreover, right lung adhesions could be predicted. Herein, we present a case of successful mitral valve repair in a patient with infective endocarditis through a redo right thoracotomy after esophageal reconstruction.Case presentationA 66-year-old male patient was diagnosed with infective endocarditis and a large anterior mitral leaflet vegetation after a previous esophageal reconstruction via right thoracotomy for esophageal cancer. Due to the retrosternal esophageal reconstruction, we performed a mitral valve repair through a redo right thoracotomy. After resecting the vegetation, the defect was closed with a fresh autologous pericardial patch. Mitral valve annuloplasty was performed. Postoperatively, antibiotics controlled the infection. The patient was discharged on postoperative day 30.ConclusionsSuccessful mitral valve repair was performed for infective endocarditis through a redo right thoracotomy after esophageal reconstruction.

Tissue-engineered and autologous pericardium in congenital heart surgery: comparative histopathological study of human vascular explants.

The goal of this histological study was to assess the biocompatibility of vascular patches used in the repair of congenital heart defects. We examined tissue-engineered bovine (n = 7) and equine (n = 7) patches and autologous human pericardium (n = 7), all explanted due to functional issues or follow-up procedures. Techniques like Movat-Verhoeff, von Kossa and immunohistochemical staining were used to analyse tissue composition, detect calcifications and identify immune cells. A semi-quantitative scoring system was implemented to evaluate the biocompatibility aspects, thrombus formation, extent of pannus, inflammation of pannus, cellular response to patch material, patch degradation, calcification and neoadventitial inflammation. We observed distinct material degradation patterns among types of patches. Bovine patches showed collagen disintegration and exudate accumulation, whereas equine patches displayed edematous swelling and material dissolution. Biocompatibility scores were lower in terms of cellular response, degradation and overall score for human autologous pericardial patches compared to tissue-engineered types. The extent of pannus formation was not influenced by the type of patch. Bovine patches had notable calcifications causing tissue hardening, and foreign body giant cells were more frequently seen in equine patches. Plasma cells were frequently detected in the neointimal tissue of engineered patches. Our results confirm the superior biocompatibility of human autologous patches and highlight discernible variations in the changes of patch material and the cellular response to patch material between bovine and equine patches. Our approach implements the semi-quantitative scoring of various aspects of biocompatibility, facilitating a comparative quantitative analysis across all types of patches, despite their inherent differences.

Effectiveness and Safety of Different Patch Materials for Supravalvar Aortic Stenosis (Middle-Term Outcomes).

To determine the effectiveness and safety of different patch materials in the treatment of pediatric patients with congenital supravalvular aortic stenosis (SVAS). 218 consecutive SVAS patients (age 14 years) who underwent surgery from Beijing Fuwai and Yunnan Fuwai hospital between 2002 and 2020 were included. Patients were divided into the pericardium patch group (133 (61.0%)), modified patch group (43 (19.7%)) and artificial patch group (42 (19.3%)). The primary safety endpoint was patch-related adverse complications (post-operation patch hemorrhage or aortic sinus aneurysm at 2-year follow-up). The primary effectiveness outcome was the re-operation or restenosis at 2-year follow-up. Multivariable cox regression was used to obtain the hazard ratio (HR). The median age at operation was 43.5 months (IQR 24.0-73.0). Only three patients had patch-related adverse complications, and no difference existed among the three groups (p = 0.763). After a median follow-up of 24.0 months (IQR 6.0-48.0), patients with a pericardium patch had a lower re-operation or restenosis rate compared with the other two groups (pericardium patch vs modified patch, HR = 0.30, 95% CI 0.12-0.77; pericardium patch vs artificial patch, HR = 0.33, 95% CI 0.13-0.82), even in the main subgroup and sensitivity analysis. In pediatric patients, the safety of autologous pericardium patch is acceptable, along with lower rates of middle-term re-operation or restenosis. http://www.chictr.org.cn, number: ChiCTR2300067851.

Abstract 12143: Hearing is Believing: A Case of a Ruptured Sinus of Valsalva Aneurysm

A 36-year-old previously active and healthy male was referred to our Adult Congenital Heart Disease clinic with worsening exertional dyspnea and intermittent palpitations over the past 6 months. He had recently been diagnosed with a membranous ventricular septal defect (VSD) and membranous septal aneurysm at another hospital, although images were not available for review.On physical exam, a continuous cardiac murmur was noted which prompted reconsideration of the diagnosis, with highest suspicion of ruptured sinus of Valsalva aneurysm (SVA). An urgent cardiac CT was obtained, which showed a large, mobile right SVA protruding into and partially obstructing the right ventricular outflow tract (RVOT), with pulmonic regurgitation and dynamic closure of a supracristal VSD (Figure 1A). A margin of the SVA was ill-defined and suspicious for rupture, although no definite communication was seen. An expedited TTE showed findings consistent with SVA rupture (Figure 1B), and he was admitted for surgery soon thereafter. Intra-operatively (Figure 1C), SVA rupture into the RVOT was confirmed by direct inspection; the SVA tissue was resected, the defect closed with a fresh autologous pericardial patch, and the VSD was closed with pledgeted sutures. Post-operatively, there was no leakage around the patch margin and only trace aortic regurgitation.A ruptured SVA causes continuous shunting from the aorta into an adjacent cardiac chamber and if left unrecognized, can lead to right heart failure, arrhythmia, and potentially sudden death, emphasizing the need for early identification. Echocardiography may show an aneurysmal sinus of Valsalva with a continuous (with accentuation in diastole) high-velocity, turbulent flow-jet into an adjacent cardiac chamber, and holodiastolic aortic flow reversal; a VSD is often present. Cross-sectional imaging is also important for diagnosis and surgical planning. A comprehensive physical exam is crucial to mitigate the risk of misdiagnosis.

Use of glutaraldehyde-treated autologous pericardial patch in complete atrioventricular septal defect repair.

Synthetic patch materials, such as polytetrafluoroethylene and knitted polyester, are commonly used for the repair of complete atrioventricular septal defects using the double-patch technique. In our study, we investigated the impact of glutaraldehyde-treated autologous pericardial patch on postoperative atrioventricular valve function. In this retrospective study, patients who underwent repair of complete atrioventricular septal defects using the double-patch technique between January 1, 2018, and May 15, 2023, at our pediatric cardiac center were included in the study. Patients were divided into two groups based on the type of patch used for the repair of the ventricular component of the atrioventricular septal defect: autologous pericardial patch (group 1) and polytetrafluoroethylene patch (group 2). Postoperative data of the patients were retrospectively analyzed. Thirty-four patients (57.6%) were female, and 25 (42.4%) were male, with a median age of 7 (5-18) months. The median body weight at the time of surgery was 5.5 (4.1-10) kilograms. Down syndrome was present in 45 (76.3%) patients. The autologous pericardium was used for ventricular septal defect closure in 44 (74.6%) patients (Group 1), while polytetrafluoroethylene was used in 15 (25.4%) patients (Group 2). Permanent cardiac pacemaker placement was required in 4 (6.8%) patients due to postoperative atrioventricular block. Hospital mortality was 11.9% (n=7). Among these cases, 4 (6.8%) patients died from low cardiac output syndrome, and 3 (5.1%) patients died from sepsis. Postoperative echocardiographic evaluation revealed insignificant residual ventricular septal defects in 17 (28.8%) patients. No significant differences were observed between the groups in terms of mortality and postoperative atrioventricular valve insufficiency. The median follow-up duration for discharged patients was 5 months (7 days to 3.9 years). Throughout the follow-up period, there were no reoperations due to valve insufficiency or left ventricular outflow tract obstruction. Glutaraldehyde-treated autologous pericardium is a safe material that can be confidently used for the repair of the ventricular component of complete atrioventricular septal defects. This patch material does not adversely affect atrioventricular valve function and allows for the successful closure of ventricular septal defects.

Staged Endoscopic Mitral Valve Repair for Active Infective Endocarditis with a Mitral Annular Abscess.

The presence of an annular abscess complicates the operation for infective endocarditis. We report a case of a totally endoscopic repair of a mitral annular abscess using a staged strategy. A 28-year-old woman underwent endoscopic mitral valve repair for active infective endocarditis (AIE) with Staphylococcus aureus. At the index operation, the mitral annular abscess was completely debrided, yielding an annular defect. The mitral valve was repaired with the autologous pericardial patch and an annuloplasty. Primary repair of the annular defect was not performed because of the fragility of edematous tissues. Two weeks after index surgery, when the infection was under control, and the scar tissue had formed around the annulus, we performed the second stage operation involving repair of the annular abscess. The scar formation enabled annular reconstruction and additional repair of the mitral valve in a totally endoscopic fashion. The postoperative course was uneventful, and there was no recurrence at 5 months. An annular abscess may be repaired with staged surgery in select situations.

Aortic arch repair with extended end-to-side anastomosis in neonates and infants with transverse arch hypoplasia

Background/Aim: The use of patches to repair the aortic arch is believed to have a positive effect on long-term morbidity. In this study, perioperative and follow-up data of patients who underwent transverse arch repair with a patch were compared with the data of patients who underwent end-to-end anastomosis (ESA). Methods: In this retrospective cohort study, the data of 27 patients (including 18 newborns) who underwent aortic arch repair at the Gazi Yasargil Education and Research Hospital between January 2018 and April 2023 were analyzed. The inclusion criteria included a diagnosis of proximal and distal transverse aortic arch hypoplasia, an age younger than 12 months of age, and the completion of aortic arch repair using cardiopulmonary bypass. Patients who underwent recoarctation repair due to residual obstruction, patients with single ventricular physiology, and patients who underwent aortic arch repair via a lateral thoracotomy without undergoing cardiopulmonary bypass were excluded from the study. The patients were divided into two groups. Group 1 included individuals who underwent aortic anterior wall expansion with autologous pericardium in addition to ESA; Group 2 included patients who underwent ESA only. Results: The median age of the patients was 21 days (range: 6–365 days), and the median body weight of the cohort was 3.5 kilograms (range: 2.4–8.9 kilograms). Enlargement with autologous pericardial patch was applied to 11 patients (40.7%). Surgical procedures performed in addition to arch repair included eight ventricular septal defect closures, six instances of pulmonary banding, three atrial septal defect closures, and one subvalvular pulmonary stenosis repair. The in-hospital mortality rate was 11.1% (n=3). Those three patients died due to sepsis. The median follow-up period was 152 days (range: 10–1316 days). Recoarctation requiring re-intervention did not occur in any of the studied patients. The antegrade selective cerebral perfusion time was statistically significantly longer in patients who underwent aortic arch repair using a patch (P=0.03). Conclusion: Repair of the arch with a patch may contribute to a reduction in long-term mortality and morbidity. However, there is a need for more comprehensive and long-term follow-up studies to verify these findings.

Delayed aorto-atrial fistula-a rare complication of tricuspid valve endocarditis.

A patient with a history of endocarditis developed a fistula between the aorta and right atrium requiring surgical repair. The patient underwent surgical intervention with closure of the fistula using an autologous pericardial patch and primary repair. This report is significant because a rare surgical pathology is visualized clearly and provides an educational value to aid other clinicians in the recognition and management of this unusual diagnosis.

Outcomes of Surgical Repair of Tetralogy of Fallot: A Comparison Between the Adult and Pediatric Population.

Introduction Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Early detection and timely treatment have provided successful repair of the anomaly in the developed world. However, in the developing world, there is still a burden of uncorrected TOF patients reaching adulthood. The goal of this study is to determine whether there is any difference in postoperative complications between adult and pediatric populationsfollowing surgical correction for TOF. Methods This study involved all those patients who received primary or secondary surgical repair for TOF in our facility between January 2017 and December 2020. The patients were split according to their age into the pediatric groupif they were under 18 years and the adult groupif they were 18 years or older. Patients with absent pulmonary valve or pulmonary atresia were not included in this study. Patients with large major aortopulmonary collateral arteries (MAPCA) were also excluded from this study. All patients underwent total correction through a median sternotomy approach. The ventricular septal defect was closed with a Bard knitted fiber patch. The right ventricular outflow tract (RVOT) was augmented by excising muscle bands or fibrous bands in the RVOT. If the annulus was smaller than the 3.5 z score, then a transannular patch was done using an autologous pericardium. The main pulmonary artery was augmented in every surgery using an autologous pericardial patch. All patients were shifted to the ICU on the ventilator and were extubated after fulfillment of the extubation criteria. Postoperative complications measured included re-opening, re-intubation, prolonged ventilation (>24 hours), and mortality within the index hospital admission. The clinical data of all patients were prospectively collected and analyzed using the chi-square test and t-test. A p-value of less than or equal to 0.05 was considered significant. Results The total number of patients was 134. This included 83 males (60.1%). A total of 114 patients who were aged below 18 years were included in the pediatric group, and 20 patients aged equal to or more than 18 years were included in the adult group. The mean average perfusion time in minutes in the adult group was 125.8 and in the pediatric group, it was 98.79. Similarly, the mean average of the cross-clamp time was also longer in the adult group at 89.55 minutes versus 69.63 minutes in the pediatric group. Overall, in the adult group, three (15%) patients had postoperative complications, while in the pediatric group, a total of 14 (11.9%) patients had postoperative complications (p = 0.001). However, there was no significant difference in the number of re-openings (8.5% vs. 10%; p = 0.8). The total mortality observed was 16 (11.59%). This included 14 (11.9%) in the pediatric group and two (10%) in the adult group. There was no significant difference between the two groups (p = 0.8). Conclusions Surgical repair of TOF can be performed in both adult and pediatric populations with acceptable outcomes. The mortality rate was found to be slightlygreater in the pediatric population compared to the adults. However, it can be seen that the number of postoperative complications is greater in adults. Further research is needed to optimize outcomes for both pediatric and adult patients with TOF.

How To Do It: Mitral Valve Translocation.

Mitral valve translocation (MVT) is a novel procedure that was developed to treat patients with severe, symptomatic, secondary mitral regurgitation (MR). MVT enhances leaflet coaptation by insertion of an autologous pericardial patch interposed between the mitral annulus and the native mitral leaflets. The patch substantially increases total leaflet surface area and creates supranormal coaptation. In addition, it relieves leaflet tethering by transposing the native valve deeper into the ventricle and decreases the circumference of the annulus. The enhanced coaptation produced by MVT may protect against recurrent MR in patients with continued adverse left ventricular remodeling. The procedural steps include detachment of the intact native mitral valve at the annulus, placement of interrupted pledgeted sutures around the annulus to secure the proximal aspect of the patch, and attachment of the native valve to the distal aspect of the patch using running suture. Follow-up of patients who have undergoing MVT is ongoing, with satisfactory short-term results, including sustained MR grades of ≤mild and 14 mm coaptation at 12 months.

Benefits of synthetic monocusp application in radical correction of Tetralogy of Fallot: early postoperative results

Tetralogy of Fallot (TF) has a worldwide prevalence of approximately 1 in 3000 live newborns, thus representing the most common cyanogenic cardiac malformation. The type of radical correction approached depends on the severity of right ventricular outflow tract (RVOT) stenosis, which is assessed depending on the Z-score of the pulmonary artery valve annulus (PAV). TF with a Z score < -3, requires PAV widening plasty with transannular application of the autologous pericardial patch. Pulmonary valve regurgitation is the most frequent and severe complication of this type of radical correction, especially in the early postoperative period. The use of a monocusp at the level of the pulmonary artery valve could reduce this phenomenon.

Decellularized cryopreserved human pericardium: a validation study towards tissue bank practice

Pericardial patches are currently used as reconstructive material in cardiac surgery for surgical treatment of cardiac septal defects. Autologous pericardial patches, either treated with glutaraldehyde or not, can be used as an alternative to synthetic materials or xenograft in congenital septal defects repair. The availability of an allogenic decellularized pericardium could reduce complication during and after surgery and could be a valid alternative. Decellularization of allogenic tissues aims at reducing the immunogenic reaction that might trigger inflammation and tissue calcification over time. The ideal graft for congenital heart disease repair should be biocompatible, mechanically resistant, non-immunogenic, and should have the ability to growth with the patients. The aim of the present study is the evaluation of the efficacy of a new decellularization protocol of homologous pericardium, even after cryopreservation. The technique has proven to be suitable as a tissue bank procedure and highly successful in the removal of cells and nucleic acids content, but also in the preservation of collagen and biomechanical properties of the human pericardium.

Pericardial Patch Aneurysm following Repair of Atrioventricular Septal Defect and Mitral Valve Replacement with 10-Year Follow-Up

A 26-year-old female patient who had surgical closure of the ventricular septal defect with an autologous pericardial patch and mitral valve repair for the cleft mitral valve in early childhood at age 4 and then subsequently mitral valve replacement with a bioprosthetic valve in 2011 at the age of 16 years, was found to have a large cystic mass protruding into the right ventricular inflow on echocardiography during a late routine examination in 2012. The cystic mass identified on echocardiography was shown to be an aneurysmal dilatation of the autologous pericardial patch used for the repair of the ventricular septal defect. As the third corrective surgery would have been inherently complicated with risk to the conduction system, she has been followed conservatively for the last 10 years without any significant complaints except mild dyspnea. This case illustrates that the pericardial patch aneurysm is relatively stable and surgery is rarely indicated unless the aneurysm causes mechanical compression or obstruction of the right ventricular inflow or outflow.

Emergent Surgical Retrieval of an Embolized Atrial Septal Occluder Device from Right Ventricle – An Unusual Occurrence

Atrial septal defect (ASD) is one of the most common congenital heart defects (3.78/10,000 live births). For several decades, surgical closure has been considered the standard method of repairing an ostium secundum ASD. Surgical treatment is safe and effective, but the complications relate to bleeding, arrhythmia, and residual defects. However, over the years, percutaneous device closure using the Amplatzer ASD occluder (AGA Medical Corp., Golden Valley, Minnesota) has been widely used for the treatment of ASD and has proven to be effective and safe as traditional surgical repair. However, procedure- or device-related complications can occur; Complications commonly associated with ASD closure device includes residual shunt, device malposition or embolization, thrombosis in the vena cava or atrium and erosion of the surrounding tissue which may lead to perforation of the heart, which could be fatal. We report an unusual case of a 16-year-old female with embolization of the ASD occluder device into the right ventricle immediately after device deployment. We removed the device surgically and closed the ASD in a standard manner, with an autologous pericardial patch. The patient was discharged from the hospital without any complications.

Restenosis Rate and Reinterventions after Aortic Arch Repair in Infants

The aim. This study aims to determine the reintervention rate in infantsundergoing aortic arch repair and to analyze risk factors and evaluate the results of reinterventions.
 Materials and methods. This retrospective study examines 445 infants with aortic arch hypoplasia who under-went aortic arch reconstruction between 2011 and 2019. The study included only patients with two-ventricle physiology and subsequent two-ventricle repair. Techniques for primary repair included extended end-to-end anastomosis (n = 348), end-to-side anastomosis (n = 611), autologous pericardial patch repair (n = 16).
 Results. The overall mortality in the entire study group was 3.3 %. Follow-up period ranged from 1 month to 9.4 years (mean 2.8 ± 2.5 years). Restenosis at the site of aortic arch repair was identiϐied in 47 (10.5 %) patients. Of these, 12 patients underwent surgical reconstruction of the aortic arch, 27 patients underwent balloon angioplasty, and in 8 patients both methods were used. Freedom from reintervention was 89.4 % at 1-year follow-up and 87.5 % at 4-year follow-up. The most determining factorsfor restenosis were related to hypoplastic proximal aortic arch and body weight less than 2.5 kg.
 Conclusions. Surgical treatment of aortic arch hypoplasia in newborns and infants is effective and shows good immediate and long-term results. Anatomical correction of reobstruction at the level of the aortic arch is safe with both endovacular and surgical methods with low mortality and incidence of repeated interventions. Identified risk factors for mortality and recurrent aortic arch interventions help to improve the treatment of aortic arch hypoplasia in patients under 1 year of age.